Provider Demographics
NPI:1336968932
Name:HANSEN-JUDD, AUDREY ROSE
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ROSE
Last Name:HANSEN-JUDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33955 EMILIA LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2068
Mailing Address - Country:US
Mailing Address - Phone:510-794-0392
Mailing Address - Fax:
Practice Address - Street 1:33955 EMILIA LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2068
Practice Address - Country:US
Practice Address - Phone:510-794-0392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
CA210056935101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool